Patient Forms

Braces & Invisalign Treatment in Kentlands, MD

You deserve a smile you feel proud to show off, and at the office of Dr. Charles C. Harrington, our mission is to help you achieve one. As a leading orthodontist serving Gaithersburg, Kentlands/Lakelands, and North Potomac, MD, we're proud to offer comprehensive orthodontic treatment ranging from standard treatments like metal braces to convenient alternatives like Invisalign. If you're ready to finally claim your own beautiful, healthy smile, we encourage you to schedule a consultation – and to help save time at your appointment and maximize your time with our Kentlands orthodontist, we've made our patient intake forms available online. 

Orthodontic Treatment Consultation Forms

We know your time is valuable, and we take every measure to make the treatment process quick, easy, and convenient. As a part of that effort, we've made it easy to fill out the necessary patient intake forms online before your initial consultation. Submitting these forms online will allow you to streamline your appointment. 

Our forms are available both as an online form and as a printable PDF, so you can choose to either submit the form online or print it and bring it with you to the office. All you'll need to fill them out is your dental insurance card and any relevant medical information for reference. 

To submit online, fill out the forms below and hit "Submit" at the bottom:

  • Child New Patient Information
  • Child & Teen Questionnaire
  • Adult New Patient Information

    If you'd prefer a hard copy, print out the forms below, fill them out, and bring them with you to your consultation:

  • Child New Patient Information (PDF)*
  • Adult New Patient Information (PDF)*

    *Please note that these forms are PDFs, so you'll need a PDF Reader program to view them. If you don't have one, we recommend downloading the free Adobe Reader. These forms are 100% secure and your information is protected.

    Contact Your Kentlands/Lakelands & Gaithersburg, MD Orthodontist
  • Orthodontic treatment is not just a pathway to a beautiful new smile: it's a way to improve your quality of life. If you'd like to learn more about our practice, the orthodontic treatments we offer, or get answers to any questions you may have about treatment, we encourage you to reach out to us at our contact page. As a leading Kentlands family orthodontist, we're proud to help patients of all ages achieve beautiful new smiles on their own terms, and we can't wait to help you do the same!

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    get_adobe_reader.gif *These forms require a PDF Reader in order to open.  If you do not have one installed, click on the link to the left to download Adobe Reader.

    **We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPPA compliant.